Background A responsive parenting intervention was found to mitigate behaviors that contribute to early childhood obesity: after intervention, mothers were less likely to pressure infants to finish a bottle, use food to soothe, or put their baby to bed with a bottle. However, whether these findings translate to real-world home environments is uncertain given the intervention sample was largely White and well-educated, with incomes greater than $50,000. We hypothesize there are mechanistic barriers to responsive parenting behaviors among diverse U.S. families; specifically, low maternal nurturing, low discipline, and low support of child development.

Methods This analysis included 7,407 U.S. mother-child dyads enrolled in the Parents as Teachers (PAT) home visiting program July 2015 through July 2020 from affiliate sites meeting the highest programmatic quality standards. Exclusion criteria due to avoid potential confounding consisted of: substance abuse, domestic violence, child abuse, incarceration, unstable housing, and mental illness, or missing data outcome variable data. In a multivariable logistic regression model examining the outcome of putting the baby to bed with a bottle ‘sometimes’ or ‘always’ compared to ‘never,’ we investigated maternal nurturing, discipline, and support of development as scored lower than the target on the Life Skills Progression instrument, while controlling for low income, low education, young parent (< age 21), multiple children younger than six years of age, single parent, first time parent, child’s age, and number of home visits.

Results In our sample of children ages 0 to 4 years, 19.5% have been put to bed with a bottle. Our sample included: 9.0% young parents, 26.1% multiple children younger than six, 17.3% single parents; 21.8% first time parents, 32.4% low education, 69.6% low income, and 5.9%, 11.9%, and 19.0% respectively scoring less than target on nurturing, discipline, and support of development. Mothers scoring low on support of development compared to scoring in the target range were more likely to put the baby to bed with a bottle (aOR: 1.3 (95% CI: 1.1–1.6)) sometimes or always versus never; nurturing and discipline scores were not statistically significant (model c-statistic: 0.66).

Conclusion Maternal gaps in knowledge of child development, unrealistic expectations, or a passive parental role are independently associated with bottle use behaviors related to early childhood obesity. Home visiting programs such as PAT that reach a diverse population, are scaled nationally, and address these values and behaviors also have the potential to help mitigate early childhood obesity.